泻土化瘀汤治疗顽固性失眠痰瘀内阻证的临床研究

发布时间：2019-02-24 10:43

【摘要】：目的:探讨泻土化瘀汤治疗顽固性失眠痰瘀内阻证的临床疗效及对单胺类神经递质和炎症因子的影响。方法:将170例符合要求的患者,根据就诊先后,采用随机按数字表法分为对照组和观察组各85例。两组均给予睡眠卫生指导、认知行为治疗、心理疗法等非药物干预措施。对照组采用艾司唑仑片,1~2 mg·d-1,睡前服用。观察组采用泻土化瘀汤治疗,1剂/d。两组疗程均为4周。进行治疗前后匹兹堡睡眠质量指数量表(PSQI),抑郁自评量表(SDS)和焦虑自评量表(SAS)评分;进行治疗前后痰瘀内阻证评分;采用多导睡眠图监测记录两组患者治疗前后总睡眠时间、睡眠期时间、睡眠潜伏期时间和醒觉次数;检测治疗前后血清白介素-1β(IL~(-1)β),肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6),5-羟色胺(5-HT)和5-羟吲哚乙酸(5-HIAA)水平。结果:观察组临床疗效总有效率为93.9%,高于对照组的80.25%,(P0.01);治疗后观察组PSQI量表睡眠质量、睡眠时间、睡眠效率、催眠药物、日间功能5个因子评分和总分均低于对照组(P0.01);治疗后观察组SDS,SAS及痰瘀内阻证评分均低于对照组(P0.01);治疗后观察组总睡眠时间长于对照组,睡眠潜伏期时间和醒觉次数少于对照组(P0.01);治疗后观察组IL~(-1)β和TNF-α水平高于对照组,IL-6水平低于对照组(P0.01);治疗后观察组5-HT和5-HIAA水平均高于对照组(P0.01)。结论:泻土化瘀汤能改善痰瘀内阻证顽固性失眠患者的睡眠质量,延长睡眠时间,临床疗效优于艾司唑仑片,其作用机制可能与调节炎症介质和单胺类神经递质水平有关。
[Abstract]:Objective: to investigate the clinical effect of Xieduhuayu decoction on intractable insomnia with phlegm and stasis and its effect on monoamine neurotransmitters and inflammatory factors. Methods: 170 patients were randomly divided into control group (n = 85) and observation group (n = 85). Both groups were given sleep hygiene guidance, cognitive behavior therapy, psychotherapy and other non-drug intervention measures. The control group was treated with eszolam tablet, 1 mg d-1, before bedtime. The observation group was treated with Xieduhuayu decoction, 1 dose per day. The course of treatment was 4 weeks in both groups. Pittsburgh Sleep quality Index scale (PSQI), Self-rating Depression scale (SDS) and Self-Rating anxiety scale (SAS) were scored before and after treatment, and internal obstruction of phlegm and stasis were scored before and after treatment. Polysomnography was used to monitor and record the total sleep time, sleep period time, sleep latency time and waking times before and after treatment. Serum levels of interleukin-1 尾 (IL~ (-1) 尾), tumor necrosis factor- 伪 (TNF- 伪), interleukin-6 (IL-6), serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) were measured before and after treatment. Results: the total effective rate of the observation group was 93.9, which was higher than that of the control group (80.25%, P0.01). After treatment, the scores and total scores of PSQI scale sleep quality, sleep time, sleep efficiency, hypnotic drugs and daytime function in the observation group were lower than those in the control group (P0.01). After treatment, the scores of SDS,SAS and phlegm stasis internal obstruction in the observation group were lower than those in the control group (P0.01), the total sleep time in the observation group was longer than that in the control group, and the sleep latency time and the number of waking times in the observation group were less than those in the control group (P0.01). After treatment, the levels of IL~ (-1) 尾 and TNF- 伪 in the observation group were higher than those in the control group, and the levels of IL-6 in the observation group were lower than those in the control group (P0.01), and the levels of 5-HT and 5-HIAA in the observation group were higher than those in the control group (P0.01). Conclusion: Xieduhuayu decoction can improve the sleep quality and prolong the sleep time of patients with internal obstruction of phlegm and stasis, and the clinical curative effect is better than that of eszolam tablet. The mechanism of Xieduhuayu decoction may be related to regulating the level of inflammatory mediators and monoamine neurotransmitters.
【作者单位】：承德医学院附属医院;
【基金】：河北省中医药管理局科研课题项目(2015159)
【分类号】：R256.23

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